Learn What Medicare Assignment Is
Medicare Made Easy
A doctor who accepts assignment has agreed to accept the Medicare-approved amount as full payment for any covered service provided to a Medicare patient. The doctor sends the whole bill to Medicare. Medicare pays the 80 percent of the cost that it has decided is appropriate for the service, and you are responsible for the remaining 20 percent.
Medicare Assignment means that your doctor or medical provider has signed an agreement with Medicare to accept Medicare’s approved amount as the full amount they will charge for services or supplies. A doctor or provider can enroll with Medicare without agreeing to accept assignments. Before you receive care or supplies it is always best to check with your provider to see if they accept Assignment or not. Using a doctor or provider that accepts Assignment will keep your co-pay and out of pocket expenses down because Medicare’s Assignment amounts are low.
Medicare Assignment is a form of payment agreement where your doctor accepts the amount paid by Medicare as full payment for their services.
Medicare assignment is a set amount agreed by Medicare and the doctor, all the services you get from them should be fully covered by Medicare.
Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.
If your doctor, provider, or supplier accepts assignment, your out-of-pocket costs may be less, they agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share, and they have to submit your claim directly to Medicare and cannot charge you for submitting the claim.
If your doctor, provider, or supplier does not accept assignment they are “Non-participating” providers and have not signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services.
If your doctor, provider, or supplier does not accept assignment, you may have to pay the entire charge at the time of service. They can also charge you more than the Medicare-approved amount, called “Excess Charges.” Excess Charges have a limit called “the limiting charge.” The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount. The limiting charge applies only to certain Medicare-covered services and doesn’t apply to some supplies and durable medical equipment.
Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you. They cannot charge you for submitting a claim. If they do not submit the Medicare claim once you ask them to, call 1 800 MEDICARE.
In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get reimbursed.
What do I do if my doctor doesn’t accept Medicare assignment?
As stated above, not all doctors accept the assignment. This means you can use your Medicare but must pay whatever is not covered with your own money.
You could possibly have to pay the full cost with your own money, then wait to be reimbursed the difference by Medicare. Please keep in mind, there’s no guarantee that Medicare will reimburse you.
Unassigned providers can charge you more than the Medicare-approved amount for certain items or services but their participation in the Medicare program prohibits them from charging more than 15% more than the approved Medicare amount. Some types of durable medical equipment and services are excluded from this 15% limit also known as the “limiting charge.”
Assignment is beneficial for the patient because the Assignment agreement stipulates that the provider is responsible for the billing process and filing a claim for payment with Medicare. By participating in assignment the provider is also agreeing to charge you only the deductible and co-insurance amount. Moreover, your payment won’t usually be billed until Medicare has paid its share of the bill. This leaves you with no risk of overpayment and trying to get reimbursed. Furthermore, the provider is responsible for submitting the claim into Medicare and handling all the necessary paperwork. A provider can’t charge you for filing the claim.
Then there are doctors who have opted out of Medicare charges. This means that whatever services they offer you, you need to pay them in full.
Unlike doctors that accept assignment, these doctors set their fee that the patient has to pay and not what Medicare states.
You’re required to pay the full amount without help from Medicare. This is why you should always confirm first whether your doctor accepts assignment or not.
Next, learn: Medicare Extra Help
Sarah began working in the healthcare industry in 2001, where she worked for many years with elderly Alzheimer and Dementia patients. From there she worked as a Group Benefits Administrator with a local healthcare company in the Human Resource Department for a period of 10 years. Since then, she has decided to work in the Medicare insurance industry full time and has joined the family business, Ashford Insurance, as a Medicare Insurance Agent.
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